Occupational Burnout Outbreak

Munich Re Life US

Do little tasks on your to-do list sometimes seem like insurmountable challenges? Are you sometimes overcome with dread on Sunday evening, contemplating the start of another workweek? Are you beginning to take on a cynical view of all things work-related? Do you feel tired all the time? If so, you may be experiencing occupational burnout.

Burnout defined Occupational burnout is the state in which you’ve exhausted all your resources but can’t rid yourself of the nervous compulsion to go on.1 Its hallmarks are emotional exhaustion, a sense of lack of accomplishment and depersonalization. When burnout is work-related, it is referred to as occupational burnout. Common symptoms include chronic indecision, lack of motivation, frequent mistakes, irritability and a sense of physical, psychological and mental overload.

Occupational burnout is not the same as depression, but those with burnout may also have depression. Generally speaking, burnout is usually work-related, whereas depression pervades all areas of life without necessarily having a specific origin.2

Psychological effects from burnout include insomnia, depression, use of psychotropic and antidepressant medications, higher incidence of hospitalization for mental disorders, and other psychological symptoms.3

Studies show that workplace burnout is a significant risk factor for coronary heart disease. Other studies found similar patterns for high cholesterol, type 2 diabetes, increased hospitalization due to cardiovascular disorders, musculoskeletal pain, prolonged fatigue, NOT IF, BUT HOW Occupational Burnout Outbreak 2/4

headaches, gastrointestinal issues, respiratory problems, severe injuries and early mortality (before age 45). Are Physicians Burned Out or Depressed? Psychological effects from burnout include insomnia, depression, use of psychotropic and antidepressant Burned out 44% medications, higher incidence of hospitalization for mental disorders and other psychological symptoms.3 Colloquially 11% History of burnout depressed The symptoms and concept of occupational burnout Clinically are not new. Even in the Bible, the book of Ecclesiastes 4% describes melancholic world-weariness. The term burnout Depressed was also found to be documented throughout the annals of occupational medicine.4 Figure 1. “Medscape National Physician Burnout, Depression & Suicide Report 2019.” January 16, 2019. The term neurasthenia was first used as early as 1829 to describe nervous exhaustion in patients run down by the “pace and strain of modern industrial life.”4 Americans in costs related to physician turnover and reduced clinical were particularly prone to neurasthenia, and resulted in hours is attributable to burnout each year. On an the nickname “Americanitis.“5 organizational level, the annual economic cost associated with physician burnout related to turnover and reduced In 1974, psychoanalyst Herbert J. Freudenberger became clinical hours is approximately $7,600 per employed the first clinical researcher to publish the term “burnout“ physician each year.8 in a psychology-related journal. The paper was based on his observations of the volunteer staff at a free clinic for Physicians are not the only high stress position at risk for drug addicts.6 burnout. In the general workforce, other job burnout accounts for an estimated $125 billion to $190 billion in health-care spending annually.9 One could assume that Psychoanalyst Herbert J. Freudenberger’s an occupational burnout epidemic might first manifest definition of burnout itself in the higher stress professions. Other industries “Burnout is a state of exhaustion and frustration where occupational burnout is becoming more prevalent caused by unrealistic expectations. It is a are social work, emergency response, design, business consumption of energy – exhaustion due to excessive development and sales, retail, public accounting and demands by family, work, friends, lovers, value law.10 systems or society – that robs a person of all energy, coping mechanisms and inner strength.”2 The Effects of Employee Burnout

Physician burnout: the canary Employees who say they very often or always in the coal mine? experience burnout at work are: 63% more likely to take a sick day A national survey published in the Archives of Internal • Medicine in 2012 reported that U.S. physicians suffer • Half as likely to discuss how to approach more burnout than other American workers. Medscape’s performance goals with their manager 2019 survey reports that physician burn-out has reached • 23% more likely to visit the emergency room extreme levels at 59%. Note that colloquial depression 2.6 times as likely to leave their current employer refers to feeling down, blue or sad, while clinical • depression is chronic severe depression not caused by a • 13% less confident in their performance grief-associated event.7 Physician burnout causes financial strain on the U.S. Figure 2. Wigert, Ben and Agrawal, Sangeeta. health care system. Cost-consequence analysis estimates “Employee Burnout, Part 1: The 5 Main Causes. that in the healthcare field, approximately $4.6 billion Gallup, 7/12/2018.

Origins of American burnout The World Health Organization (WHO) recognizes work- related burnout as an occupational phenomenon. WHO It is theorized that in the future, burnout will affect more stressed that “burnout” is not classified as a medical than just workers in acutely high-stress environments. condition but as an occupational syndrome. Symptoms of Burnout has also been viewed as a generational condition. burnout include: The term “burnout” is sometimes used interchangeably 1. Feelings of exhaustion with “Millennial burnout.” 2. Cynicism about one’s job As American business became more efficient, the working 3. Difficulty doing the job successfully. environment became more competitive. American workers feel they have been conditioned to believe that WHO now includes burnout in their International they should be working all the time. Generational groups Classification of Diseases (ICD) Handbook. The ICD-10- such as Gen X and Millennials, were optimized from a CM Code Z73.0 is the billable ICD code used to specify a young age to be the best workers possible.11 Unlike diagnosis of burnout. A "billable code" is detailed enough previous generations, they did not have clear demarcations to be used to specify a medical diagnosis.15 between when they were on and off the clock. According to WHO, doctors can issue a diagnosis of Additionally, individuals did not enjoy typical forms burnout if a patient exhibits three symptoms: of leisure activity, as they instead felt guilty for not 1. Feeling depleted of energy or exhausted working. Thus, there is no respite from the workplace.12 Unfair treatment at work, unreasonable deadlines, 2. Feeling mentally distanced from or cynical about unmanageable workload, lack of support from managers one‘s job and having to respond to emails and texts during off 3. Problems getting one‘s job done successfully. hours are primary drivers of job burnout.9 WHO notes that burnout is to be used specifically “in During this era of COVID-19, we have seen many stories the occupational context” and that it “should not be of burnout among hospital employees; however, it is applied to describe experiences in other areas of life.” affecting many more workers outside of the medical They recently announced plans to update the definition of community, sometimes with serious consequences. burnout for the next edition of WHO’s ICD-11 Handbook, Countless office workers have been suddenly thrust into a which will come into effect in January 2022.14 It is worth remote work environment. With no dedicated office space noting that occupational burnout is still not listed in the and no childcare available, employees are forced to juggle Diagnostic and Statistical Manual of Mental Disorders being present and productive at work with being available Fifth Edition (DSM-5) from the American Psychological to care for and often entertain their children. Stretched- Association (APA). thin parents are working longer and non-conventional Currently, there is no neat or universal way to isolate hours. According to a recent monster.com survey of those symptoms of burnout from symptoms of other mental working from home, more than 50% are experiencing health conditions, such as depression. This makes it burnout and 52% of respondents don’t have any plans to extremely difficult for doctors to recognize and treat the take time off to decompress, which can lead to further syndrome, and in some professions like healthcare and 13 burnout and additional health complications. law, it’s considered an epidemic.16

Burnout as a diagnosis Burnout solutions and treatment

The ICD-10-CM code 273.0 is used to code Burnout prevention programs have usually focused on Occupational Burnout cognitive restructuring, didactic stress management, and relaxation. Cognitive-behavioral therapy (CBT), relaxation techniques and schedule changes are often used for Burnout is a type of psychological stress. Occupational reducing or preventing burnout. A multi-directional burnout or job burnout is characterized by exhaustion, approach, combining both organizational and individual- lack of enthusiasm and motivation, feelings of level activities, may yield the greatest results.17 ineffectiveness, and also may have the dimension Maslach and Leiter postulated that burnout occurs when of frustration or cynicism, and as a result reduced there is a disconnection between the organization and the efficacy within the workplace.14 individual with regard to what they called the six areas of work life: workload, control, reward, community, fairness, and values. Assuring that a worker has adequate resources to meet job demands as well as ensuring

a satisfactory work–life balance can help revitalize employees’ energy.18 Clearly stated ethical organizational values are important for ensuring employee commitment. Supportive leadership and relationships with colleagues are also beneficial.18 Companies need healthy, committed and qualified employees to be successful. Not only is an employee’s physical and mental health important, but companies must also be mindful of employee motivation, job satisfaction and work climate.2 Disability provider ramifications

Mental/nervous and substance abuse disability claims carry an added level of complexity under the best circumstances. Insurers should make sure policy limitations are adequately worded to cover burnout diagnoses. Also, consideration should be given to the possibility of increased incidence of disability, due to occupational burnout and potential generational implications, by re- evaluating existing underwriting guidelines to address this new diagnosis.

References

Jody Elmore 1. Cohen, Josh. “Minds Turned to Ash.” The Economist, August/September Senior Risk Management Consultant 2016, https://www.1843magazine.com/features/minds-turned-to-ash. Group Living Benefits 2. Gunti, P. “Burnout – more than just a fashionable complaint.” March 2011, https://www.myhandicap.com/en/information-disability-chonical- Munich Re Life US illness/health-and-aids/mental-health/burnout/. 3. Cassella, Carly. “Burn-Out” Is Now a Legitimate Syndrome According to the WHO. Here Are The Symptoms.” Science Alert, May 29, 2019. https:// www.sciencealert.com/burn-out-is-now-officially-recognised-as-a- legitimate-syndrome-by-the-world-health-organisation. 4. Cohen, Josh. “Not Working: Why We Have to Stop.” Granta Books. January Todd A. Tucker, FLMI, ARA, ACS, AIAA 1, 2019. Group Underwriting Consultant 5. Marcus, G (1998-01-26). "One Step Back; Where Are the Elixirs of Yesteryear When We Hurt?” The New York Times. Group Living Benefits 6. Freudenberger, H.J. (1974). "Staff burnout". Journal of Social Issues. 30: Munich Re Life US 159–165. doi:10.1111/j.1540-4560.1974.tb00706.x. 7. Kane, Leslie MA. “Medscape National Physician Burnout, Depression & Suicide Report 2019.” January 16, 2019, https://www.medscape.com/ slideshow/2019-lifestyle-burnout-depression-6011056#2 8. Han, Shasha, MS; Shanafelt, Tait D., MD; Christine A., Sinsky, MD; Awad, Karim M., MD; Dyrbye, Liselotte N., MD, MHPE; Fiscus, Lynne C., MD, MPH; Trockel, Mickey, MD; Goh, Joel, PhD. “Estimating the Attributable Cost of Physician Burnout in the United States.” Annals of Internal Medicine, June 4, 2019. 9. Kraft, Sheryl. “Companies are facing an employee burnout crisis.” CNBC.com. August 28, 2018, https://www.cnbc.com/2018/08/14/5- ways-workers-can-avoid-employee-burnout.html. 10. Montañez, Rachel. “The 6 Industries Where People Experience Burnout the Fastest.” Fairygodboss. https://fairygodboss.com/articles/ the-6-industries-where-people-experience-burn-out-the-fastest. August 2, 2019. 11. Harris, Malcolm. “Kids These Days: Human Capital and the Making of Millennials.” Little, Brown and Company. 12.Peterson, Anne Helen. “How Millennials Became The Burnout Generation.” BuzzFeed News, January 5, 2019. 13.ICD.Codes. https://icd.codes/icd10cm/Z730. © 2019. 14.Perry, Susan. “Global health officials recognize job burnout as a serious ‘syndrome’.” MINNPOST. May 29, 2019, https://www.minnpost.com/ second-opinion/2019/05/global-health-officials-recognize-job-burnout- as-a-serious-syndrome/. 15.Ivanova, Irina. “World Health Organization classifies work "burnout" as an occupational phenomenon.” CBS Interactive Inc., May 28, 2019. https:// www.cbsnews.com/news/world-health-organization-classifies-work- burnout-an-occupational-phenomenon-2019-05-28/. 16.Rikinkumar S Patel, Shiana Sekhri, Narmada Neerja Bhimanadham, Sundus Imran, and Sadaf Hossain. “A Review on Strategies to Manage Physician Burnout.” NCBI, June 3, 2019. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC6682395/. 17.Maslach, C.; Schaufeli, W. B.; Leiter, M. P. (2001). S. T. Fiske; D. L. Schacter; C. Zahn-Waxler (eds.). "Job burnout." Annual Review of Psychology. Volume 52, 2001: 397–422. doi:10.1146/ annurev.psych.52.1.397. 18.Monster Staff. “Overworked from Home.” Monster.com. undated, https:// www.monster.com/career-advice/article/overworked